symptoms and signs of valvular disease Flashcards
valvular heart disease:
Any disease involving one or more — of the heart
Classified according to
1- —-involved as :
2- Nature of —
Stenosis – valve opening is — (blood flow through valveis –)
Regurgitation – valve is — (blood flows in —direction to normal flow)
valves
valves involved as
Mitral
Tricuspid
Aortic
Pulmonary
lesion
narrowed
resitriced
leaky
opposite
pathophysiology:
1- Valve stenosis
A — valve that results in — and– blood flow through the valve
Most commonly caused by — / — of the valve
Risk factors for aortic stenosis include advanced age, hypertension, hyperlipidaemia, diabetes
2-Valve incompetence
A — valve that results in blood flowing – through the valve
May be caused by valve prolapse,MI, rheumatic heart disease
arrows
impaired and turbulent
athersolcorsis / calcicifcation
leaky
back
symptoms of aortic stenosis:
— for – period
Presenting Symptoms:
—- on exertion or decreased — tolerance
Exertional — and —
Exertional – (Remember mnemonic SAD – Syncope/angina/dyspnoea)
End-stage symptoms
— , — , —
asymptomatic
prolonged
shortness of breath
expertise
dizziness and prescyncope
angina
heart failure, syncope,angina
1- Symptoms of Aortic regurgitation are — , — , —
2- symptoms of mitral stenosis:
3- symptoms of mitral regurgitation :
Often —
Dyspnoea/ heart failure
PND/orthopnoea, fluid retention, decreased exercise tolerance
Fatigue
Palpitations (atrial fibrillation)
+/- Symptoms suggestive of IE
1-
Palpitations
Shortness of breath
Fatigue
2-
Shortness of breath
Fatigue
Right sided heart failure signs (late)
3- asymptomatic
Signs Of Aortic Stenosis:
Pulse:
May be normal in mild AS
Slow-risingand low volume-“ParvusetTardus”
NARROW pulsepressure
Apex:
Heaving/sustained,non-displaced
Palpation:
Thrill (usuallyoveraortic area, sometimesovercarotidsalso), best heard with patient sitting forward
Auscultation:
*Ejectionsystolicmurmur
*Audible click after S1 (usually in younger patients)
*If severe - soft S2 with reverse splitting may be heard
*Heardloudestataorticareaon expiration
*Shape:Crescendo-decrescendo
*Quality:Harsh
*Radiation:Carotids
*+/-S4
Signs of Aortic Regurgitation
Pulse:
WidepulsepressureCollapsingpulse
Apex:
Some displacement,thrusting
Auscultation:
*Early diastolicmurmur
*HeardatLLSE,heard bestwithpatientleaning
forwardsinfullexpiration
*Radiation:Noradiation
*+/-S3
Signs of Mitral Stenosis:
Apex:
Tappingapex
Apex:
Some displacement,thrusting
Auscultation:
*Mid-diastolicmurmur
*Heardatapex,loudestwhenpatientis inLeftLateralposition withbreathheldinexpiration
*Quality:Low-pitch,rumbling
*Radiation:Noradiation
*Openingsnapmaybeheard
Other
*Mitralfacies / Malar flush
SiGNs of mitral regurgitation:
Pulse:
Generally normal in chronic MR
Apex:
Inferolateraldisplacement,brisk/hyperdynamic
Palpation:
Thrillmayoccurinacute onsetMR,orinseverechronicMR
Auscultation:
*Pansystolicmurmur
*Heardloudestatapex
*Shape:Pan/holosystolic
*Quality:Blowing
*Radiation: LeftAxilla
*Soft S1
*+/-S3
*Audibleclickifmitralprolapse
what is murmur:
-an – phenomenon produced by — blood flow.
-Abnormal blood flow across valves and cardiac chambers produce — or — that are detectable with a – .
-When a murmur occurs outside the heart (e.g. in AAA or narrowing of Carotid artery) they are usually referred to as—.
acoustic
turbulent
vibrations or sounds
stethoscope
bruits
Sign Causes – Pulse Pressure:
Narrow pulse – decreased — leads to a — response increasing outflow and vascular resistance to sustain — BP. Results in reduction in— BP. The — vascular resistance results in a narrow pulse
Widened Pulse – attributed to the—-volume flow of the— into the — during —. Result in — arterial stiffness/reduced compliance and increased pulse wave velocity
stroke volume
sympathetic
diastolic
systolic
icreased
high
left ventricle —> asending aorta
systole
increased
malar flash is seen in — due to the —- which causes — of the arterioles in the cheeks
mitral stenosis
c02 retention
vasodilation
symptom causes:
Chest pain– Due to an increase — demand from ventricular wall
Shortness of breath and fatigue – Occurs due to —- failure
Syncope – On exertion patient is unable to increase — throughstenosed valve in setting of peripheral vasodilation, leading todecreased cerebral perfusion
Palpitations– Normally associated with — due to left atrial —
02
left ventricular systolic failure
cardiac output
arterial fibrillation
enlargement
differential diagnosis:
The differential diagnosis for any murmur is any other valve that could be causing the same – during the same – of the cardiac cycle (diastolic vs systolic)
Differential for systolic murmurs include AS/MR/TR/PS
Differential for diastolic murmurs include AR/MS/TS/PR
Systolic murmurs can also be caused by —
Murmurs may also be caused by — blood flow through a cardiac septal defect
noise
phase
hypertrophic obstructivecardiomyopathy (HOCM)
turbulent
summary:
Valvular heart disease can occur in any valve
Most common are aortic stenosis and mitral regurg
Right sided(Tricuspid and Pulmonary)valvularconditions arerare,mainly seen in congenital conditions
Aortic stenosis most common valvular heart disease requiring intervention.
Mitral stenosis is the second most common VHD requiring intervention.
Mitral stenosis rarer in developed nations due to decrease in rheumatic fever, however still prevalent in developing nations.
